Therapeutic aims of drugs offering only progression-free survival are misunderstood by patients, and oncologists may be overly optimistic about likely benefits.

PURPOSE: The use of novel and often expensive drugs offering limited survival benefit in advanced disease is controversial. Treatment recommendations are influenced by patient characteristics and trial data showing overall response rates (ORR), progression-free survival (PFS) and overall survival (OS). PFS is frequently the primary outcome in licencing studies. PATIENTS AND METHODS: As part of a longitudinal study Assessing the 'VALue' to patients of PROgression Free Survival (AVALPROFS), oncologists completed checklists at baseline following consultations with patients. Questions probed perceived clinical benefits of the drugs to populations in general. Patients completed study-specific interview schedules at baseline, 6 weeks into treatment, and at withdrawal due to toxicity or progression. Patients also completed tumour- and treatment-specific quality of life questionnaires monthly for their time in the study. Only baseline results are reported here. RESULTS: Thirty-two UK oncologists discussed management options with 90 patients with heterogeneous advanced cancers. Oncologists' estimates of medical benefit in general from treatment varied between 10 and 80 %. They expected 46/90 (51 %) of their patients to derive some clinical benefit from the prescribed treatment but were either unsure or expected none for 44/90 (49 %). Predictions of life expectancy were variable but 62 % (56/90) of patients were expected to survive longer with treatment. A majority of patients 51/90 (57 %) had 'no idea' or were 'unclear' what PFS meant and 45/90 (50 %) thought extension of life was the primary therapeutic aim of treatment. CONCLUSION: Discussions between doctors and patients with metastatic disease about future management plans and likely therapeutic gains are challenging. Factors influencing decisions about putative benefits of novel drugs are often applied inconsistently can be overly optimistic and may even contradict published data.

Individual inconsistency across measures of inhibition: an investigation of the construct validity of inhibition in older adults.

Inhibition is a central construct to the frontal lobe theory of ageing, yet its construct validity remains unproven. Furthermore, age effects on measures of inhibition are often reported without adequate control for the effects of global slowing on performance. We investigated inhibitory function in older adults in two experiments. In Experiment 1, 49 people with ages between 59 and 86 (mean=70 years 9 months S.D.=7.54) completed four analogues of the Stroop interference paradigm. To control for global slowing and to enable comparisons across all measures, we used a random effects model based on log-transformed response times. Age did not contribute significantly to the model and the estimated correlation between tasks was not significant. In Experiment 2, 33 people with ages between 62 and 86 (mean=73 years 4 months, S.D.=6.57) were compared on two measures of Stroop-like interference which were very similar in surface task demands. Age did not contribute significantly to the model but the estimated correlation between tasks was robust (r=0.714). We conclude that age may make little contribution to inhibitory function independently of other factors such as speed and intelligence. Second, that the level of individual consistency in the performance of measures of inhibition will depend on the similarity of the tasks used.